Timing, Distribution and Predictors of Mortality Following a Road Traffic Injury in Northwest Ethiopia: A Hospital-Based Prospective Follow up Study

Abstract

BackgroundRoad traffic injury-related mortality continues to increase from time to time globally, but its burden is more than three times higher in low-income countries. This discrepancy is mainly due to poor trauma care system both at the pre-hospital and in-hospital. The analysis of injury patterns and time to mortality is crucial for the development and improvement of trauma care systems. This study aimed to identify patterns of RTI , and predictors of mortality following a RTI. MethodsA prospective hospital-based follow up study was conducted among road traffic injury victims admitted to Gondar University Hospital between May 2019 and February 2020. The total follow-up time was 30 days. Injury severity was determined using revised trauma score (RTS). A Cox regression model was used to identify the time to death and predictors of mortality. Hazard ratios (HR), attributable risks (AR) and population attributable percent (PAR) were computed to estimate the effect size and public health impacts of road traffic injuries.ResultsA total of 454 victims were followed for 275,534 person-hours. There were 80 deaths with an overall incidence of 2.90 deaths per 10,000 person-hours of observation (95% CI: 2.77, 3.03). The significant predictors of time to death were being a driver (AHR=2.26; 95% CI: 1.09, 4.65, AR=14.8), accident at inter urban roads (AHR=1.98; 95% CI: 1.02, 3.82, AR=21%), hospital arrival time (AHR=0.41; 95% CI: .16, 0.63; AR= 3%), SBP on admission (AHR= 3.66; 95% CI: 2.14, 6.26; AR=57%), GCS of <8 (AHR= 7.39; 95% CI, 3.0819 17.74464;AR=75.7%), head injury with polytrauma (AHR= 2.32 (1.12774 4.79; AR=37%) and interaction of distance from hospital with pre-hospital care.ConclusionThis study demonstrated that trauma deaths follow the classical tri-modal pattern in low resource settings. Interventions on pre hospital care, and advancing the hospital trauma care system is required to reduce preventable deaths caused by road traffic injuries. We recommend further study that assess capability of primary hospitals in the area in providing primary trauma care.

Incidence and predictors of mortality among road traffic accident victims admitted to hospitals at Hawassa city, Ethiopia

“…Low systolic blood pressure at admission was a significant predictor for mortality among road traffic accident victims in our study. This finding is in agreement with previous studies that confirmed victims with low systolic blood pressure were at increased risk of death, which might be due to acute blood loss [12,21,26,36]. Poor blood perfusion to the vital organs due to low systolic blood pressure leads to a decompensation state with multiple organ failure and could increase mortality among road traffic accident victims [37].…”

“…; those victims who had a low GCS value were at a higher risk of death than those who had a high GCS value at admission [22,31,36]. And also in our studies, victims with severe head injuries (GCS�8) had the highest incidence of mortality, which is in line with other studies conducted in Ethiopia [12,38].…”

“…This study indicated the incidence of mortality among road traffic accidents was 7.34 per 10,000 person-hours of observations. This result is higher when compared to studies conducted in Iran 4.51 per 10,000 [25], and Ethiopia 2.9 per 10,000 and 1.0 per 10,000 [12,26]; the possible explanation for this disparity could be that our study was merely conducted on cases admitted to the hospital at least for 24 hours that signal severity of injury to victims. Another might be the difference between hospitals in their emergency management and critical care set-ups.…”

“…The first day and hour to start to follow up was the selected victim registered at the date 1 st January 2019 at 2:30 am. Victims followed for 30 days whether or not the event was to occur until the discharge date [12].…”

“…in Yemen, Ghana, the D.R. Congo, and Ethiopia where the rate of death was higher among the age group below 50 Years [12,20,21,25]. The possible reason behind this is the fact that the older age group might have decreased immunity and comorbidities, making them more susceptible to nosocomial infection and unable to respond to treatment.…”